Provider Demographics
NPI:1124385042
Name:WISE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WISE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-308-8934
Mailing Address - Street 1:23 NANCY CIR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-8943
Mailing Address - Country:US
Mailing Address - Phone:610-308-8934
Mailing Address - Fax:
Practice Address - Street 1:15050 KUTZTOWN RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9275
Practice Address - Country:US
Practice Address - Phone:610-683-5686
Practice Address - Fax:610-683-8773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007644L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
50083540OtherCAPITAL BLUE CROSS
PA0716259000OtherINDEPENDENCE BLUE CROSS
PA11908776OtherCAQH
PAWI20742OtherHIGHMARK
PA1417034802OtherINDIVIDUAL NPI
PA422764OtherHEALTH AMERICA, HEALTH ASSURANCE
PA1417034802OtherINDIVIDUAL NPI